Name of procedure: Squint Surgery (Child)

Eye Surgery Surgical procedure information leaflet Name of procedure: Squint Surgery (Child) This leaflet is for parents whose child has a squint that may be helped by an operation. In this leaflet we explain some of the possible benefits and risks of surgery and we mention alternatives to surgery. If we have suggested that a squint operation may be a good idea for your child, we want you to have an informed choice so that you can make the right decision for your child. We recommend that you read this leaflet carefully. Please ask us about anything you do not fully understand or want explained in more detail. What is a squint (strabismus)? Normally, both eyes work together as a pair and point towards the object the child is looking at. A squint is present when one eye is not pointing in the direction it is supposed to. A squint may affect only one eye or it may alternate (swap between the eyes). A squint may be constantly present or intermittent. The angle (size) of the squint may be slight or obvious, and it may vary. Wearing glasses may affect a squint, so that children who need glasses must have been wearing them before the doctor can advise about squint surgery. What is a lazy eye (amblyopia)? In most children with a squint affecting only one eye, the squinting eye is found to have poor vision it is lazy (amblyopic). This means that the brain is not learning to use the message from this eye. Treating a lazy eye is generally done before any squint surgery and may need to continue afterwards. The child wears glasses if needed and then the treatment for the lazy eye involves patching the good eye or making the good eye blurred with eye drops. This treatment aims to improve the vision in the lazy eye: it will not help the squint. What is squint surgery for? In most cases, the aim of surgery is to improve the appearance of a squint by reducing its size: the surgery will not improve the vision. Sometimes the treatment plan involves more than one operation. Also, if the eyes do not work together as a pair, there will be a life-long tendency to squint, so that further operations may be needed in the future. In some cases, the aim of surgery is to help the eyes to work together as a pair. This may help preserve the vision in each eye and keep the eyes pointing in the right direction in the long term. What are the alternatives to squint surgery? You may decide that a squint operation is not wanted, particularly if the squint is simply a matter of cosmetic appearance and you feel that the appearance of the eyes is acceptable. However, if a squint is constantly present, a child is very unlikely to grow out of it. It is not necessarily a good idea to wait until the child is old enough to decide for themselves, as a younger child may adapt better to surgery than a teenager. Some kinds of intermittent squint may be controlled using special glasses but this may not be a long-term solution. Very occasionally, it may be appropriate to inject a tiny amount of Botox into an eye muscle to see what effect this has on a squint. Investigate procedure information leaflet 1 of 7 Version 1.5

What is the pre-op assessment? This appointment is usually 1 2 weeks before surgery. The size of the squint will be remeasured by an orthoptist, and you will have the opportunity to discuss squint surgery with the doctor. It is important that you understand the type of operation that is planned for your child and any risks associated with the surgery. The doctor will then make a recommendation about squint surgery. Older children will usually be involved in making decisions about the operation. If you agree to your child having a squint operation done, you will be asked to sign a consent form. Your child will have a nursing and medical assessment. A nurse will show your child a book of pictures about what will happen. The nurse will discuss the anaesthetic and the operation and invite you to ask questions. If your child s health changes between this appointment and the day of surgery, please ring Miss Thurairajan s secretary on (01905) 760302 or Mr Nair s secretary on (01527) 512132. A significant cold or cough usually means the operation has to be postponed: taking antibiotic medicine will probably not alter this. What happens during the operation? The operation is planned as a day case with no overnight stay in hospital. The surgery is performed with the child asleep using a general anaesthetic. The operation usually takes between 30 and 90 minutes. The surgeon will cut open the clear skin of the white of the eye. Then the surgeon will adjust one or more of the muscles that move the eye in order to weaken or strengthen their effect. The eye remains in its socket during the operation. The operation may be on one eye or both eyes and surgery is sometimes appropriate on an eye that is not squinting. Will the operation cure a lazy eye or the need for glasses? In general, children who wear glasses will continue to need them after squint surgery. After surgery, a child who has had a lazy eye (amblyopia) may still require treatment using patches or drops. What are the risks of squint surgery? A doctor experienced in anaesthetics for children will give the anaesthetic. It is not possible to completely remove risk, but modern anaesthetics are very safe. Although most squint operations improve the squint, all surgery carries risks and squint surgery is no different. In rare cases a muscle may slip behind the eye and this may be difficult to sort out. Very rarely, the inside of the eye may be damaged, which could lead to permanent loss of sight. After the operation, some soreness, redness and stickiness are expected and often increase during the first few days. You will be given eye drops to take home that help control these symptoms. Blood under the skin of the white of the eye can cause a patch of redness lasting for up to 3 weeks. Older children sometimes notice double vision, but this usually disappears within two weeks. When the eyes have settled after surgery, the effect of the operation on the muscles will be measured. Not all children will respond to surgery in the same way and occasionally the effect will be either too much or not enough, so that further surgery may be appropriate. Instructions about eating and drinking before the operation If there is food or liquid in your child s stomach during the anaesthetic, it could come up into the back of the throat and then damage his or her lungs. Children must not eat anything after 2am on the night before the operation. From this time until 6am on the day of the operation they may drink water or dilute cordial, but they are not allowed other drinks such Investigate procedure information leaflet 2 of 7 Version 1.5

as milk, fruit juice or fizzy drinks. At 6am on the day of the operation, children should be offered one cupful of water or dilute cordial. After 6am they must not eat or drink anything and must not chew chewing gum. What happens on the day of surgery? Please attend for surgery with your child at 8am. If your child normally takes medication at home, please bring it with you. The anaesthetist will come to see you and your child. The anaesthetist needs to find out about your child s general health, previous experiences of an anaesthetic, any medicines your child is taking, any allergies he or she might have and whether your child has any wobbly teeth. The anaesthetist may prescribe some medicines for your child to take before the operation. Your child may have local anaesthetic cream put on their hand or arm. This cream is used before injections and usually prevents them hurting. It is usual that one parent is welcome to come to the anaesthetic room and stay with the child until the child is unconscious. Your child may have either an anaesthetic gas to breathe or an injection through a cannula (a thin plastic tube put into the back of their hand using a needle). When your child is unconscious, the nurse will take you back to the ward. After the operation, when your child is awake, he or she will be returned to you on the ward. Some children are upset when they first wake up but then settle. Some children feel dizzy or sick, but when it is appropriate, the nurse will offer something to drink and then something to eat. When the nurses are happy you can take your child home. (This will be after at least two hours on the ward.) Sometimes children have a sore throat after the anaesthetic, which may take a day or two to settle. (Paracetamol can be taken to ease any discomfort.) We will give your child pain-relieving drugs before or during the anaesthetic to make sure that your child is as comfortable as possible after surgery. Before you leave hospital, we will give you any extra medication that your child will need to take after going home. What happens after the surgery? After squint surgery eyes are not covered or padded. Tears may be bloodstained for a few days. You will be given eye drops (containing an antibiotic and a steroid) to use 4 times a day for 2 weeks. (In schoolchildren, drops do not necessarily need to be given at school.) If necessary, eyes may be cleaned by wiping the closed eyelids with clean cotton wool that has been dipped in cooled boiled water. Normally, children who wear glasses should continue to do so after the operation. Most children return to nursery or school after a few days. Your child should not swim or do contact sports for 4 weeks. To reduce the risk of children rubbing their eyes during the first 4 weeks after surgery, extra care should be taken to avoid getting soap or shampoo in the eyes. Some redness of the eye may last until the stitches have dissolved (up to two months). If you have concerns during the period after the operation, please telephone the eye department at Kidderminster (01562) 512382 or Redditch (01527) 507915 or Worcester (01905) 733569. Your child will be seen in the outpatient clinic about two weeks after the operation and again after about three months, to check the result of the surgery when healing is complete. (Most children will then need further clinic visits during which the vision is monitored.) Preparing your child for what will happen Depending on your child s ability to understand, you should explain what is going to happen and encourage your child to talk about it. The explanation given by the nurse at the pre-op assessment is a good guide as to what to say to your child. It is good for older children to feel that they have agreed to have the operation. Investigate procedure information leaflet 3 of 7 Version 1.5

Any Questions? At the pre-op assessment you will meet an orthoptist, a nurse and an eye surgeon. If you have questions or concerns this is a good time to raise them with a member of the team. Otherwise, we would like you to contact us using the contact details below. Contact details telephone numbers Eye Department at Worcester (01905) 733569 Eye Department at Redditch (01527) 507915 Eye Department at Kidderminster (01562) 512382 Day Surgery Nursing Staff, Kidderminster Hospital (01562) 512384 Ward 1 Nursing Staff, Alexandra Hospital, Redditch (01527) 512095 Miss G Thurairajan s secretary on (01905) 760302 Mr R Nair s secretary (01527) 512132 Anaesthetic Department, Worcestershire Royal Hospital (01905) 760637 Anaesthetic Department, Alexandra Hospital, Redditch (01527) 503858 Information on the internet The following websites have information that you may find useful: www.worcestershirehealth.nhs.uk/acute_trust Information about Worcestershire Acute Hospitals NHS Trust. www.patient.co.uk Information fact sheets on health and disease. www.nhsdirect.nhs.uk On-line Health Encyclopaedia and Best Treatments Website. www.rcoa.ac.uk Leaflets about anaesthetics from the Royal College of Anaesthetists. Patient Services Department It is important that you speak to the eye department team (see the list of contact details above) if you have any questions (for example, about medication) before the operation. If you have any concerns about your treatment, you can contact the Patient Services Department on 01527 512177 or extension 42177. The Patient Services staff will be happy to discuss your concerns and give any help or advice. If you have a complaint and you want it to be investigated, you should write direct to the Chief Executive at Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester WR5 1DD or contact the Patient Services Department for advice. Investigate procedure information leaflet 4 of 7 Version 1.5

Please contact Patient Services on 01527 512177 if you would like this leaflet in another language or format (such as Braille or easy read). Bengali Urdu Portuguese Polish Chinese Comments We would value your opinion on this leaflet, based on your experience of having the operation done. Please put any comments in the box below and return them to the Clinical Governance Department, Management Centre, Worcestershire Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD. Name of leaflet: Squint Surgery (Child) Date: Comments: Thank you for your help. Investigate procedure information leaflet 5 of 7 Version 1.5